The Prevalence of Overweight/Obesity and Related Comorbidities among HIV-Positive and HIV-Negative Patients Attending the Same Clinics in Gaborone, Botswana

Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countries like Botswana where ±84% of PLHIV is on ART, the paucity of data comparing overweight/obesity between HIV-positive on ART and HIV-negative patients may impede clinical and policy decision-making. This study sought to estimate and compare: i) the prevalence of overweight/obesity between HIV-positive on ART and HIV-negative patients;ii) the prevalence of hypertension (HTN), diabetes mellitus (DM)/coronary heart disease (CHD) between HIV-positive patients on ART and HIV-negative patients attending same outpatient departments of general clinics in Gaborone, Botswana. Patients and Methods: Five hundred eighty-one (581) outpatients were recruited in four major clinics of Gaborone, Botswana, between June and July 2019;294 or 51% of them were HIV-negative and 287 or 49% were HIV-positive on ART. The prevalence of overweight/obesity and of HTN and DM/CHD were calculated and examined using stratified analysis. Subgroups were compared using Chi-square analysis with Yates correction or Fisher exact test and t-student test for continuous data. Results: Major findings after stratification of the study population by HIV status were: i) the prevalence of all categories of (BMI), including overweight/obesity, were comparable between HIV-negative-patients and HIV-positive. In fact, there were 24 (8.0%) cases of underweight among HIV-negative-Patients and 15(5%) cases among HIV-positive patients, p = 0.2;145 (49%) HIV-negative-patients and 128 (45%) HIV-positive, p = 0.07 cases of normal weight;72 (25%) HIV-negative-patients and 87 (30%) HIV-positive, p = 0.08, were overweight;53 (18%) HIV-negative-patients and 57 (20%) HIV-positive, p = 0.12, were obese;125 (43%) HIV-negative patients and 144 (50%) HIV-positive, p=0.06 were overweight/obese;ii) the prevalence of HTN and DM/CHD among HIV-positive-patients were significantly lower (p < 0.05) compared to HIV-negative patients: There were 32 (10.9%) cases of HTN among HIV-negative patients compared to 18 (6.3%) cases of HTN among HIV-positive patients, p = 0.001;32 (11%) cases of DM/CHD HIV-negative patients compared to 4 (1.4%) cases of DM/CHD among HIV-positive patients, p = 0.001. Conclusion: the prevalence of overweight/obesity observed between HIV-negative and HIV-positive patients may suggest that the two groups shared the same exposure factors. That HTN and DM/CHD prevalence was lower among HIV-positive compared to HIV-negative patients, is possibly due to interplay factors of ART, HIV or the host population. Further studies are, however, recommended for clarifications.

Practice environment related barriers to exclusive breastfeeding among HIV-positive mothers in Blantyre, Malawi

Rates of exclusive breastfeeding in Malawi remain low despite the acknowledged benefits of exclusive breastfeeding for the infant’s wellbeing and the prevention of mother-to-child transmission of HIV. Creating an environment supportive of exclusive breastfeeding is critical to increase the rate of exclusive breastfeeding among HIV-positive mothers. However, little is known on factors that influence the environment within which HIV-positive mothers in Malawi practise exclusive breastfeeding. Therefore, the exploratory qualitative study on which this article is based was conducted at the Chatinkha maternity unit of Queen Elizabeth Central Hospital in Malawi from April 16, 2009 to May 8, 2009 to explore perceived practice environment related barriers to exclusive breastfeeding among HIV-positive mothers. Data were obtained through indepth interviews with 16 purposively selected breastfeeding HIV-positive mothers between 18 and 35 years old and two focus group discussions with women of unknown HIV status. Semi-structured interview and focus group guides were utilised. Content analysis of data was done. Five main themes emerged regarding factors that may influence the environment within which exclusive breastfeeding was practised: 1) availability of resources;2) societal norms and cultural practices;3) mother-baby proximity;4) health workers’ attitudes and 5) disclosure of the mothers’ HIV status. A multi-sectoral approach to promote exclusive breastfeeding is suggested. This?should include community involvement because it is in the community where breastfeeding norms and cultural practices associated with breast-feeding are propagated.

Baseline Laboratory Profile of HIV Positive Patients on Antiretroviral Therapy in Jos North Central Nigeria: Implications for Pre-vention, Treatment, Care and Support

Background: We characterized baseline laboratory data of patients to identify priority treatment areas, most affected populations, anticipated clinical complications and assessed the potential burden of retention in care in Jos, Plateau State—North Central Nigeria. Methods: This study was a cross-sectional design from January 2004 to December 2005 at Faith Alive Foundation (FAF). All participants were HIV-positive and underwent pre-antiretroviral therapy counseling based on the national antiretroviral therapy (ART) guidelines and baseline laboratory testing. Data were captured on Microsoft Excel, validated on Epi Info and analyzed on SPSS version 21 at P < .05 level of significance. Results: Total of 1499 (463 men and 1036 women) participants were evaluated in this study. The age and sex related distribution of participants showed that majority (80.3% for males and 92.5% for females) were 16 - 45 years old. Amylase and creatinine were significantly higher in males than females (P = .02). Anaemia was the most common baseline abnormality (63% for females and 58% for males), while baseline CD4 count was significantly lower in males than females (P < .02) and at one-third had elevated liver enzymes (AST and ALT). Conclusion: The baseline laboratory profile of most HIV positive patients in Jos and environs of North Central–Nigeria was characterized by anaemia, elevated creatinine, and abnormal liver transaminase levels (AST and ALT). This pre-ART laboratory result suggests that HIV-positive individuals have multiple clinical abnormalities which may require more extensive care than just treating the HIV disease.

Does HIV Status Affect Utilization of Maternal Care Services among Women in India: An Analysis of NFHS 2005-2006

The objective of the study is to understand the relationship between HIV status, fertility and utilisa-tion of maternal care services in India using the NFHS 2005-2006 data. The mean number of children ever born (a measure of fertility) is substantially higher among HIV-negative women than among the HIV-positive women (2.8 and 2.1 respectively). Ten-year age specific fertility rates (ASFR) were calculated, there is no noticeable difference in pattern of ASFR between HIV-positive and HIV-negative category of women observed though the ASFRs were substantially lower among the HIV-positive women. The total fertility rate (TFR) among HIV-positive women (0.84) is substantially lower at one third of the TFR among HIV-negative women (2.78). The proportion of HIV-positive pregnant women utilising ANC services is 92 percent compared to 78 percent among HIV-negative women, who have alive birth during the 5-year preceding the survey. Similarly, the proportion of HIV-positive women (67%) delivering their babies in an institution is also much higher than among HIV-negative women (40%). This study concludes that the effort of the government to integrate ART services with maternity care services is likely to have benefited the HIV positive mothers.

Assessment of Antiretroviral Efficacy of the Medicinal Synthetic Aluminum-Magnesium Silicate {Al4(SiO4)3 + 3Mg2SiO4 → 2Al2Mg3(SiO4)3}

HIV/AIDS patients were treated, daily, with MSAMS (50 mg/kg), MSAMS-stabilized Ampicillin trihydrate (7.5 mg/kg) and immunace extra-protectionM? (1 tablet), for one month and then, with only MSAMS and the immune stimulants. They were tested, monthly, for viral loads and CD4- lymphocytes counts. Those whose viral loads became undetectable were tested for HIV confirmation (antigens/antibody). Their mean-viral load increased (P = 0.020) from 1820.30 ± 868.75 to 2855.90 ± 960.98 after first month, before reducing (P = 0.0.030) to: 1565.20 ± 743.17;759.20 ± 473.65;345.50 ± 115.01;192.80 ± 97.40;95.00 ± 55.80;37.40 ± 26.46;17.50 ± 16.88 (undetectable). Their mean-CD4 count was 496.80 ± 194.39 (lymphopenia). It reduced (P = 0.008) to 263.90 ± 149.26 after first month, before increasing (P = 0.001) to: 507.90 ± 133.19;692.70 ± 113.34;840.20 ± 139.41;1007.30 ± 163.50;1537.10 ± 302.10;1924.60 ± 247.45;2707.00 ± 837.87 (lymphocytosis). Patients whose viral loads became undetectable tested HIV-negative, one month after. CD4-lymphocytes count, approximating to zero-viral load, calculated from equation (Y = 2297.80 - 1.4731X) of line of best fit of graph of their viral loads onCD4-lymphocytes counts, was 1559.84/ml.

Use of real-time polymerase chain reaction for the diagnosis of Pneumocystis pneumonia in immunocompromised patients： a meta-analysis

Background The diagnosis of Pneumocystis pneumonia （PCP） in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic examinations. Herein, we performed a meta-analysis to evaluate the accuracy of real-time polymerase chain reaction （PCR） in the diagnosis of PCP. Methods We searched Web of Knowledge and Medline from 1990 to May 2010 for studies reporting diagnostic accuracy data regarding the use of real-time PCR in the diagnosis of PCP in immunocompromised patients. Results Ten individual studies were included. Overall, the sensitivity of real-time PCR was 97% （95% CI： 93%-99%）; the specificity was 94% （95% CI： 90%-96%）. The area under the HSROC curve （95% CO for real-time PCR was 0.99 （0.97-0.99）. In a subgroup analysis regarding studies involving HIV patients among the study population, the sensitivity and specificity were 97% （95% CI： 93%-99%） and 93% （95% CI： 89%-96%）, respectively. Regarding studies using Bronchoalveolar lavage （BAL） samples only： sensitivity =98% （95% CI： 94%-99%）; specificity =93% （95% CI： 89%- 96%）, respectively. Regarding studies using microscopy as a reference standard： sensitivity =97% （95% CI： 92%-99%）; specificity =93% （95% CI： 88%-96%）. However, high between-study statistical heterogeneity was observed in all analyses. Conclusions Real-time PCR has a good diagnostic accuracy and may provide a useful adjunctive tool for the diagnosis of PCP in immunocompromised patients. Further studies are needed in order to identify any differences in the diagnostic performance of real-time PCR in HIV and non-HIV immunocompromised patients.